How to Spot the Signs of an MS Flare?

Around 90 percent of people with multiple sclerosis are first diagnosed with flares, attacks, or aggravations. Scientifically known as relapsing-remitting MS (RRMS). These are the periods where symptoms keep occurring at certain intervals. While people continue to have relapses, along with a general progression of symptoms and disability in their later stages of RRMS or secondary progression.

MS is a progressive neurological condition with wax and wane which affects the central nervous system that is responsible for various functions including coordination and balance. This is an autoimmune condition in which our own antibodies start attacking and destroying the nerve cells of our own body.

Multiple sclerosis deals with certain indicative episodes that may reappear after several months or years and you may experience some symptoms you may have had before and now getting worse, or a few new symptoms may appear. MS involves stints of time like good and bad times, in bad times your symptoms may shoot up and those worse periods are called −

  • Flare-ups

  • Periodic incidents

  • Attacks

  • Regression

  • Irritations

What Is an MS Outbreak?

An MS attack can cause new symptoms to appear, worsening the old symptoms. These symptoms can be mild to severe interfering with our daily activities like disturbing our ability to function normally. They vary from person to person; no two exacerbations are alike.

Some regressions cause to produce only one symptom like inflammation in a distinct area of the central nervous system, while other regressions may cause more than two symptoms at a time in one or more areas of the central nervous system. Most MS attacks may last for a few days to several weeks or even months.

Is It a Flare or a False Attack?

Most of the people get confused for a false attack and a flare. MS flares occurs in the brain and spinal cord causing inflammation, damaging the myelin sheath that protects the nerve fibers.

Confirming a true or false flare, the attack must endure for at least 30 days after the previous flare, and the most recent symptoms must remain for at least 24 hours.

When these new symptoms disappear in less than 24 hours, it’s considered as a pseudo-flare or false attack. A few causes of pseudo-attacks include −

  • Overheat in the body.

  • Humidity

  • Weakness

  • Fatigue

  • Fever

Sometimes stress and depression can also cause false attacks. If these false symptoms prevail, no new symptoms are being observed in the central nervous system. Whereas, when true flares exist there might be a chance of new symptoms to raise in the central nervous system.

Signs of a Flare

The signs and symptoms of an imminent MS flare basically include any of the potential symptoms. They vary from flare to flare and person to person. True flares can constantly exacerbate over the course of time, these flares consist of loss of function and negative symptoms and commonly last for many days.

Most people start to notice a few signs that anticipate symptoms of a flare. During an MS flare, a person may trigger a few common symptoms. However, these MS symptoms are unique to each person and some of which are as follows −

  • Body mind coordination problems.

  • Loss of vision or blurred eyesight.

  • Dizziness.

  • Problems with balance and coordination.

  • Bladder issues.

  • Numbness in limbs and fingers (pins and needles).

  • Loss of memory.

  • Fatigue.

  • Low concentration levels.

  • Nervous disability.

  • Improper brain functioning.

  • Depression.

  • Pain, Tremor.

  • Improper balancing.

Proper monitoring of your feelings from day to day can help you hook those flares early. It is the best way to maintain a balance between noticing and changes occurring in your body

Treating Flare-Ups

It is not necessary that all flares require treatment. Mild episodes or attacks or changes typically don’t impact your daily life and can mostly be left untreated as they get better on their own. The treatment mainly focuses on stimulating the recovery rate from attacks, regulating the symptoms, and waning the disease breakthrough.

The common treatment for MS flares includes a high dose of steroids, usually administered orally or intravenously over three to five days. Steroids lower inflammation and speed up the recovery process.

A few people cannot tolerate or respond to these steroids, for those people there are a few other treatment options like −

  • Physiotherapy

  • Occupational therapy

  • Infusion treatments

  • Oral treatments

  • Muscle relaxants

Some of the treatment options to be considered for flare-ups include −

  • Corticosteroids − These are steroids that can calm down inflammation in a short period.

  • H.P. Acthar gel − This is an injectable treatment generally used in place of corticosteroids when they are not being effective.

  • Plasmapheresis − This is a plasma exchange treatment method. In this method, your blood plasma will be replaced with new plasma cells. It is used for severe flare-ups.

What Factors Trigger Flare?

According to research studies, most people with MS experience flare-ups around the course of their disease. MS symptoms cause inflammation in the central nervous system damaging myelin and causing MS flare-ups. There are several factors that trigger flare-ups and prompt them to cause disease

Physical or Mental Pressure

A stressful life may increase the occurrence of flare-ups. People with a heavy workload and disturbed family life are more prone to MS.

The connection between stress and flare-ups are strongest so keep in mind that over-stress is the initial step causing MS flare. One can take various measures to lower their stress levels, which include −

  • Avoid heavy work load.

  • Proper exercising.

  • Organise eating habits.

  • Sound sleep.

  • Meditation.

  • Yoga practice.


Some common infections of upper respiratory infections like flu and cold can cause MS flare-ups. So, you can take proper care to reduce your flares like −

  • Avoid cold or frozen food items.

  • Wear a mask while going out in cold weather.

  • Try to be warm by wearing sweaters and gloves.

  • A flu shot is recommended.

  • Immediately get treated for Urinary tract infections (UTIs).

  • Wash hands.

  • Maintain a proper distance in public.

Medical Procedure

Some people assume that surgeries and anesthesia may bring flare-ups. People with advanced MS and respiratory problems may have a higher risk of aggravations with anesthesia, but not flare-ups. However, anesthesia is considered safe for people who live with MS.

It’s important to remember that anesthesia involves a risk of disease onset, but not a flare-up.

Booster Shots

Getting a booster shot or vaccination is raising concerns in recent years. People with MS are even more concerned and bothered about flare-ups or severe MS symptoms.

Research studies confirmed that vaccines do not aggravate MS. Studies went on all kinds of booster shots like hepatitis B, flu vaccines, and even COVID-19 vaccines.

In a few conditions, it is better to avoid vaccines. A few of those conditions include −

  • While experiencing a flare-up.

  • While taking certain medications.

Added Risk Factors

There are a few other risk factors that may prone flare-ups. Older people are probably more prone to flare-ups. Added risk factors for flare-ups are identified as −

  • Vitamin D serum levels.

  • Smoking habit.

  • DMTs.

  • Heat overexposure.

  • Excess alcohol consumption.

How Long Do They Last?

Length of action of a flare-up may vary for each flare-up and each person. A few Flare-ups may only last for a few days, but some can stay for weeks and even months. To entitle a flare-up, symptoms must endure for at least 24 hours.


“Prevention is better than cure” The proverb may be old, but it is the fact. Flare-ups can happen suddenly without any warning signs. However, they can be prevented by following a few important steps

  • Maintaining good health can be the 1st step for everyone, but it is more important for people living with MS

  • Taking in nutrient and protein-rich food can involve preventing infections and further we can prevent flare-ups or MS symptoms.

  • Smoking may affect and bring flare-ups and it may increase the chance of chest and respiratory infections causing MS symptoms. So, quit smoking to prevent an MS flare.

Recovery Tips

Recovery is totally based on the type of flare you are suffering with. Since flare-ups are different for each person.

Consider your lifestyle and observe the activities that need to be changed to recover well.

Some flare-ups take a long time to disappear. Take time off from work and get help from people around if possible or consider professional home help, such as assistance from social service organizations or appoint a nurse.

A few emotional issues also raise due to these flare-ups like anxiety and depression which makes it even worse. Talk with your healthcare professional for good support to treat these emotional issues.

Your doctor may help you find out the right kind of concern specialist to assist in your recovery in the easy possible way.

Updated on: 24-Feb-2023


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